Cardiology: Hyperlipidemia

Question 1

Is more cholesterol taken in from the diet or produced in the liver?

Answer 1

produced in the liver

Question 2

This lipoprotein carries dietary lipids form the intestine to the liver, skeletal muscle and adipose tissue…

Answer 2

Chylomicrons

Question 3

this lipoprotein carries newly synthesized TAGs from liver to adipose tissue

Answer 3

VLDL

Question 4

This type of lipoprotein is not usually detectable in the blood

Answer 4

IDL

Question 5

This lipoprotein carries cholesterol from the liver to the body’s cells

Answer 5

LDL

Question 6

Why is LDL dangerous?

Answer 6

because it delivers cholesterol to the tissues, which can form plaques and lead to atherosclerosis

Question 7

This lipoprotein collects cholesterol from tissue, including vascular endothelium, and returns it to the liver.

Answer 7

HDL

Question 8

Why is HDL the “good” lipoprotein?

Answer 8

its reverse transport from tissues to liver protects against heart disease

Question 9

Food provides ____ of our cholesterol, while the liver produces the remaining _____.

Answer 9

food: 25%

Liver: 75%

Question 10

Cholesterol from the diet resulting in increased chylomicrons represent the ______ pathway of lipid metabolism

Answer 10

exogenous

Question 11

lipid metabolism in the liver resulting in production of VLDL, LDL, and IDL is the _______ pathway

Answer 11

endogenous

Question 12

HDL pathway of lipid metabolism is also called…

Answer 12

reverse cholesterol transport

Question 13

Familial hypercholesterolemia, polygenic hypercholesterolemia and familial combined hyperlipidemia are examples of what kind of disorder?

Answer 13

Inherited increased lipid disorders.

Etiology: genetic

Question 14

Inherited increased lipid disorders should be suspected in what patient population?

Answer 14

1st degree relatives of someone with hx of premature atherosclerotic cardiovascular disease (ASCVD)

Question 15

Which disorder is the most common autosomal dominant genetic disease?

Answer 15

Familial hypercholesterolemia

Question 16

Familial hypercholesterolemia is ________ meaning it results from a defect in ____ gene(s)

Answer 16

monogeneic, 1 gene

Question 17

What is more common, heterozygous familial hypercholesterolemia or homozygous familial hypercholesterolemia?

Answer 17

heterozygous

Question 18

Heterozygotes can expect a _____x LDL value while homozygotes can exhibit a _____x LDL.

Answer 18

Hetero: 2x

Homo: 8x

Question 19

A patient presents with cardiac sxs and a FH of ASCVD. There father died of an MI at age 45.

What is your suspected dx, how is this confirmed, and how is it treated?

Answer 19

Dx: familial hypercholesterolemia

Confirmed by: genetic testing

treat with Statins +/- add-on

Question 20

These two inherited increased lipid disorders present very similarly, expect this disease is controlled by multiple genes.

Answer 20

Polygenic hypercholesterolemia

Question 21

How do you treat all inherited increased lipid disorders?

Answer 21

statin +/- add-on tx

Question 22

This disease is a polygenic disease that has a wide variety of lipid abnormalities. It is relatively common (1-2% of population) and present in 30-50% of familial CHD

Answer 22

familial combined hyperlipidemia

Question 23

A patient presenting with hx of familial CHD should be screened for _______ because it is most common in the population and is present in 1/3-1/2 of familial CHD.

Answer 23

familial combined hyperlipidemia

Question 24

what is more common, inherited hyperlipidemia or secondary hyperlipidemia?

Answer 24

inherited

Question 25

STEP 1: ATHEROSCLEROSIS LDL molecules diffuse from blood thru the ________ at a rate that is dependent on _________

Answer 25

diffuse thru ENDOTHELIUM at rate dependent on CONENTRATION

Question 26

STEP 2: ATHEROSCLEROSIS ________ follows LDL through endothelium, becoming ________cells that contain ________. When they die, they release _________ and form deposits

Answer 26

MACROPHAGES follow become FOAM CELLS that contain CHOLESTEROL release CHOLESTEROL when they die

Question 27

STEP 3: ATHEROSCLEROSIS what does the body do in reaction to deposit formation from lysed foam cells?

Answer 27

increased collagen to form a cap

Question 28

STEP 4: ATHEROSCLEROSIS When the ________ ruptures, a ________ can form and lead to _________

Answer 28

COLLAGEN CAP ruptures forming THROMBUS leading to INFARCT

Question 29

decision to screen for atherosclerosis should be based on...

Answer 29

overall CHD risk, independent of lipid levels

Question 30

``` HTN DM TOBB OBESITY HDL < 40 HYPERLIPIDEMIA ``` What type of risk factors are these?

Answer 30

Modifiable CHD Risk Factors

Question 31

an HDL of _____ or greater is a negative risk factor for CHD

Answer 31

60

Question 32

Why does a fasting lipid panel require a 12 hour fast?

Answer 32

TAGs are affected by eating

Question 33

is serum cholesterol affected by eating prior to phlebotomy?

Answer 33

no

Question 34

A fasting lipid panel gives you which markers?

Answer 34

Total Cholesterol, TAGs, LDL, HDL

Question 35

Acute coronary syndrome and acute MI can do what to a lipid panel?

Answer 35

falsely low levels 24-48 hrs after MI, persisting for 60 days

Question 36

Cholesterol Values- Desirable: High Risk:

Answer 36

Desirable: < 200 High Risk: > 240

Question 37

Triglyceride Values- Desirable: High Risk:

Answer 37

Desirable: < 150 High Risk: 200-499

Question 38

HDL Values- Desirable: High Risk:

Answer 38

Desirable: 60 High Risk: < 35

Question 39

LDL Values- Desirable: High Risk:

Answer 39

Desirable: 60-130 High Risk: 160-189

Question 40

soft, yellow plaques in various places like eyelids, palms, axilla and chin.

Answer 40

Plane Xanthoma

Question 41

Plane xanthomas are associated with...

Answer 41

familial or secondary hypercholesterolemia

Question 42

yellow-orange nodules commonly located over knees and elbows

Answer 42

tuberous xanthoma

Question 43

a tuberous xanthoma found on tendons is called....

Answer 43

tendinous xanthoma

Question 44

tuberous xanthoma is associated with...

Answer 44

familial hypercholesterolemia

Question 45

- small red-yellow papules - abrupt onset - located on extensor surfaces and buttocks

Answer 45

Eruptive xanthomas

Question 46

what causes eruptive xanthomas?

Answer 46

elevated TAGs, > 1500

Question 47

eruptive xanthomas are associated with...

Answer 47

familial hyperlipidemia

Question 48

a white or grey ring around the cornea

Answer 48

cornal arcus

Question 49

a patient exhibits corneal arcus without elevated lipids. Age is >40. Is this concerning?

Answer 49

no, common finding in pts over 40

Question 50

The DASH diet has demonstrable effects on what markers?

Answer 50

BP, LDL, and risk of CHD/Stroke

Question 51

An exercise program to address CHD should include...

Answer 51

3-4 40 minutes sessions/week of moderate to vigorous exercise

Question 52

The only class of drugs to demonstrate clear improvements in overall mortality in primary and secondary prevention of CHD.

Answer 52

statins (HMG CoA reductase inhibitors)

Question 53

What tests should be obtained to measure a baseline prior to initiating statin therapy?

Answer 53

lipid panel LFTs CK

Question 54

To assess adherence and percent response to statins and lifestyle changes, a repeat lipid panel should be done every_______

Answer 54

4-12 weeks after starting or does adjustment

Question 55

when a statin does has been titrated to the preferred therapeutic response, how often should monitoring via lipid panel, LFTs and CK take place?

Answer 55

every 3-12 months

Question 56

What are three appropriate responses to an intolerance or poor response to statin therapy?

Answer 56

1. reinforce importance of adherence to meds and lifestyle changes 2. exclude secondary hyperlipidemia 3. investigate tolerance

Question 57

are bile acid sequestrants safe during pregnancy?

Answer 57

yes

Question 58

The four statin benefit groups are:

Answer 58

1. clinical ASCVD Dx 2. LDL 190 or higher 3. DM 40-75 yo with LDL 70 or higher 4. LDL 70-189 and 10 yrASCVD risk 7.5% or greater

Question 59

LDL 190 or higher is treated with...

Answer 59

high intensity statin, no risk assessment needed to start tx

Question 60

DM aged 40-75 pt. is treated with...

Answer 60

risk assessment to determine moderate or high intensity statin

Question 61

If a patient is 40-75 with LDL 70-190 and no DM... treat with...

Answer 61

calculate 10 year ASCVD risk

Question 62

uncomplicated 40-75 yo pt. with LDL 70-190. ASCVD risk "low" (< 5%)... tx?

Answer 62

lifestyle factors only

Question 63

uncomplicated 40-75 yo pt. with LDL 70-190. ASCVD risk "borderline" (5-7.4%)... tx?

Answer 63

moderate intensity statin

Question 64

uncomplicated 40-75 yo pt. with LDL 70-190. ASCVD risk "intermediate" (7.5-20%)... tx?

Answer 64

moderate intensity statin to reduce LDL 30-49%

Question 65

uncomplicated 40-75 yo pt. with LDL 70-190. ASCVD risk "High" (< 50%)... tx?

Answer 65

initiate statin to reduce LDL 50%

Question 66

This drug: lowers LDL SE: liver toxicity, myopathy, drug interactions

Answer 66

Statins

Question 67

This drug: decreases TGs Toxicity when used with statin most useful with hyperTGemia

Answer 67

Fibrates

Question 68

If myositis is suspected during statin therapy, what should be done?

Answer 68

stop therapy, check CK and LFTs

Question 69

This drug: Raises HDL, Lowers LDL don't use w/ statin, must monitor LFTs must be titrated slowly to moderate side effects SE: flushing

Answer 69

niacin

Question 70

This drug: lowers LDL safe in pregnancy Can increase TGs SE: diarrhea and other GI issues

Answer 70

bile acid sequestrants

Question 71

This drug: statin add-on decreases LDL

Answer 71

Ezetamibe

Question 72

when shouldn't you combine ezetamibe and statins?

Answer 72

pts with liver disease

Question 73

This drug: profoundly decreases LDL used as statin adjunct or in statin intolerance Expensive, injection

Answer 73

PCSK9 inhibitors